Summary Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0.83, 95% CI 0.63–1.09; p=0.18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1.91, 1.06–3.44; p=0.0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0.82; appendix); these events included pulmonary embolism (two patients [<1%] vs four [1%] patients; p=0.41) and sepsis (seven [1%] vs six [1%]; p=0.79). Interpretation In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients (smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with cancellous screws. Funding National Institutes of Health, Canadian Institutes of Health Research, Stichting NutsOhra, Netherlands Organisation for Health Research and Development, Physicians’ Services Incorporated.

Fecal microbiota transplant has become more acceptable as a therapeutic for recurrent Clostridium difficile infection. The FDA has an enforcement discretion policy for practitioner's performing this therapy, which includes informed consent for this experimental treatment. This manuscript describes a typical procedure that can be followed that includes the important aspects of this preparation and treatment.

Clostridium difficile infection (CDI) is a leading cause of nosocomial infection and isassociated with significant morbidity and mortality. Immunocompromised (IC) patients are particularly at higher risk. Recurrence rates of up to 60 % have been reported after the third episode despite treatment with antibiotics. Recent published reports of fecal microbiota transplantation (FMT) in the IC population have shed light that the procedure proves to be effective and safe. No studies that compare the efficacy and adverse event rate of FMT between IC and non-IC patients currently exist The aim of our study is to compare the response and serious adverse event (SAE) rates of FMT for recurrent or refractory CDI (RCDI) between IC patients and non-IC patients.We performed a single-center retrospective study on patients who received FMT for RCDI in a single tertiary care center. Donor stool was obtained from a universal donor, friend, or relative. We used a standardized protocol for preparation of stool used for FMT. Patients received FMT through the upper gastrointestinal route or by colonoscopy. Those who failed initial FMT were eligible to receive additional FMT.Patients were considered IC as a result of one or more of the following: HIV infection (any CD4 count), AIDS-defining diagnosis or CD4<200/mm 3 , inherited or primary immune disorders, active malignancy, and immunodeficient or immunosuppressed from a medical condition/medication including current or recent (<3 months) treatment with anti-neoplastic

SUMMARY The emptying of a solid meal labelled with Indium ll3mDTPA from the stomach was studied with a gamma camera in 26 normal subjects, 27 patients with duodenal ulcer, on 41 occasions after truncal vagotomy and pyloroplasty and 38 times after highly selective vagotomy. Applying the method of principal component analysis to the results, differences were detected between control and duodenal ulcer subjects and two probable subgroups of duodenal ulcer were observed. Half emptying times did not reveal these patterns. After vagotomy, delayed emptying was general at one week. At one month, patients after highly selective vagotomy had a more normal result than those with truncal vagotomy and pyloroplasty (TV), but by six months no significant difference in overall emptying rate was found, although changes in the pattern of gastric emptying persisted in some patients after TV.The unpleasant sequelae of diarrhoea and dumping which sometimes complicate vagotomy and pyloroplasty (TV) have been attributed to rapid gastric emptying (McKelvey, 1970;Clarke and Alexander-Williams, 1973). In order to avoid these disturbances, the operation of highly selective vagotomy (HSV) has been advocated (Johnston and Wilkinson, 1970). Experimental evidence showed that antral motility was less disturbed after HSV than after TV (Kelly and Kennedy, 1971;Wilbur and Kelly, 1973) and clinical trials suggested that the incidence of dumping and diarrhoea was also less in patients after HSV (Amdrup et al., 1974). However, the evidence for a more controlled rate and pattern of gastric emptying with HSV was less convincing. When liquid meals were used, the rate of emptying after HSV was still more rapid than normal (Moberg et al., 1972;Clarke and Alexander-Williams, 1973). With 'nutritional' contrast meals the rate of emptying was said to be normal (Pederson and Amdrup, 1970;Madsen et al., 1973), but this method was capable of measuring only total emptying times and was therefore relatively crude compared with other techniques.With solid meals some preliminary reports are available. In one gastric emptying was found to be normal after HSV.

FMT is a generally safe and effective treatment option for older adults with CDI.